Laparoscopy-assisted transduodenal papillectomy: how we do it (with video)

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Early ampulla of Vater neoplasms may be suitable for limited resections due to low metastasis risk.
• Transduodenal papillectomy is less demanding than endoscopic approaches for limited resections.
• Standard pancreatoduodenectomy (PD) may be excessive for select early-stage ampullary tumors.

Purpose of the Study:

• To demonstrate a standardized laparoscopy-assisted transduodenal papillectomy (LATDP) technique.
• To evaluate LATDP as a diagnostic and therapeutic approach for early ampulla of Vater neoplasms.
• To present a minimally invasive alternative to standard PD.

Main Methods:

• The LATDP technique involves three steps: laparoscopic Kocher mobilization, papillectomy, and reconstruction.
• A laparoscopy-assisted approach minimizes tumor exposure, reducing intra-abdominal dissemination risk.
• This procedure acts as a comprehensive biopsy for staging.

Main Results:

• LATDP allows for assessment of tumor extent and lymph node status.
• The procedure provides sufficient surgical margins.
• It helps in deciding the necessity of subsequent pancreatoduodenectomy.

Conclusions:

• LATDP is a minimally invasive and oncologically safe procedure.
• It offers benefits over pure laparoscopic or endoscopic techniques.
• LATDP should be considered in the surgical management of early ampulla of Vater neoplasms.